Etomidate: Difference between revisions
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==General== | ==General== | ||
*Type: [[Sedation|Sedative]] | *Type: [[Sedation|Sedative]] | ||
*Dosage Forms: | *Dosage Forms: IV | ||
*Common Trade Names: Amidate | *Common Trade Names: Amidate, Tomvi | ||
==Adult Dosing== | ==Adult Dosing== | ||
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==Pediatric Dosing== | ==Pediatric Dosing== | ||
''See [[critical care quick reference]] for drug doses by weight.'' | ''See [[critical care quick reference]] for drug doses by weight.'' | ||
*Children < 10 years | |||
**0.2-0.3 mg/kg IV | |||
*Children > 10 years | |||
**0.3 mg/kg IV | |||
==Special Populations== | ==Special Populations== | ||
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* apnea | * apnea | ||
===Controversy=== | ===Controversy=== | ||
"The available evidence suggests that etomidate suppresses adrenal function transiently without | *May suppress adrenal function in critically ill patient | ||
**"The available evidence suggests that etomidate suppresses adrenal function transiently without | |||
demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."<ref>*Hohl CM, Kelly-Smith CH,Yeung TC, Sweet DD, Doyle-Waters MM, Schulzer M. The effect of a bolus dose of Etomidate on cortisol levels, mortality, and health services utilization: a systematic review. Ann Emerg Med. 2010;56(2):105-113.</ref> | demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."<ref>*Hohl CM, Kelly-Smith CH,Yeung TC, Sweet DD, Doyle-Waters MM, Schulzer M. The effect of a bolus dose of Etomidate on cortisol levels, mortality, and health services utilization: a systematic review. Ann Emerg Med. 2010;56(2):105-113.</ref> | ||
*Meta-analysis in 2023 showed increased mortality in critically ill patients | |||
==Pharmacology== | ==Pharmacology== | ||
Latest revision as of 01:39, 13 June 2024
See critical care quick reference for drug doses by weight.
General
- Type: Sedative
- Dosage Forms: IV
- Common Trade Names: Amidate, Tomvi
Adult Dosing
RSI
- 0.3mg/kg bolus IV
- Average: 20mg
- Consider half-dose (0.15mg/kg) for obtunded patients
Procedural Sedation
- 0.1mg/kg one time dosing
- Max: 10mg
- Minimal respiratory depression but decrease blood pressure and heart rate (alpha2 agonism)
Pediatric Dosing
See critical care quick reference for drug doses by weight.
- Children < 10 years
- 0.2-0.3 mg/kg IV
- Children > 10 years
- 0.3 mg/kg IV
Special Populations
- Pregnancy Rating: C
- Lactation: etomidate is present in breast milk
- Renal Dosing
- Adult
- Not defined however higher risk of toxicity with renal impairment
- Pediatric
- Not defined however higher risk of toxicity with renal impairment
- Adult
- Hepatic Dosing
- Adult
- Not defined
- Pediatric
- Not defined
- Adult
Contraindications
- Allergy to class/drug
Adverse Reactions
- Myoclonus
- Nausea/Vomiting
- Pain at injection site
- apnea
Controversy
- May suppress adrenal function in critically ill patient
- "The available evidence suggests that etomidate suppresses adrenal function transiently without
demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."[1]
- Meta-analysis in 2023 showed increased mortality in critically ill patients
Pharmacology
- Half-life: 75 minutes
- Metabolism: Liver
- Excretion: Urine
- Mechanism of Action: GABA agonist
See Also
References
- ↑ *Hohl CM, Kelly-Smith CH,Yeung TC, Sweet DD, Doyle-Waters MM, Schulzer M. The effect of a bolus dose of Etomidate on cortisol levels, mortality, and health services utilization: a systematic review. Ann Emerg Med. 2010;56(2):105-113.
Etomidate: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.